scholarly journals Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Xiuxue Feng ◽  
Enqiang Linghu ◽  
Ningli Chai ◽  
Zhongsheng Lu ◽  
Xiangdong Wang ◽  
...  
Keyword(s):  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Gastric Body ◽  
Controlled Study ◽  
Resected Specimen ◽  
En Bloc ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection ◽  
The Mean

Aim. To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods. The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results. The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P=0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P=0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions. ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.

scholarly journals Endoscopic Submucosal Tunnel Dissection as a Novel Therapeutic Technique in Patients With Barrett’s Esophagus

2020 ◽  
Vol 8 ◽  
pp. 232470962094131
Author(s):  
Faisal Inayat ◽  
Simcha Weissman ◽  
Adnan Malik ◽  
Badria Munir ◽  
Shahzad Iqbal
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Future Research ◽  
En Bloc ◽  
Therapeutic Technique ◽  
Endoscopic Techniques ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection

With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions.

scholarly journals Development of a Novel Gastrointestinal Endoscopic Robot Enabling Complete Remote Control of All Operations: Endoscopic Therapeutic Robot System (ETRS)

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Keiichiro Kume ◽  
Nobuo Sakai ◽  
Toru Ueda
Keyword(s):  
Remote Control ◽  
Flexible Endoscopy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resected Specimen ◽  
Robot System ◽  
En Bloc ◽  
Total Procedure Time ◽  
Mean Size ◽  
The Mean

Background and Objective. The master and slave transluminal endoscopic robot and other flexible endoscopy platforms are designed primarily for the remote control of forceps, with manipulation of the endoscope itself still dependent on conventional techniques. We have developed an endoscopic therapeutic robot system (ETRS) that provides complete remote control of all forceps and endoscope operations. Method. We carried out endoscopic submucosal dissection (ESD) in porcine stomachs using the ETRS. All procedures were completed with the endoscopist seated at the console the entire time. Results. Total en bloc resection was achieved in all 7 cases with no complications. The mean total procedure time was 36.14±14.98 min, the mean size of the resected specimen was 3.39±0.66 cm×3.03±0.63 cm, and the mean dissection time was 14.91±8.61 min. Conclusion. We successfully used the ETRS to perform completely remote-controlled ESD in porcine stomachs.

scholarly journals Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeongseok Kim ◽  
Jisup Kim ◽  
Eun Hye Oh ◽  
Nam Seok Ham ◽  
Sung Wook Hwang ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Neuroendocrine Tumors ◽  
Similar Efficacy ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
The Mean

AbstractSmall rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

En Bloc Resection of Lamina and Ossified Ligamentum Flavum in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1181-1186 ◽  
Author(s):  
Lian-shun Jia ◽  
Xiong-sheng Chen ◽  
Sheng-yuan Zhou ◽  
Jiang Shao ◽  
Wei Zhu
Keyword(s):  
Evaluation System ◽  
Ligamentum Flavum ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Dysfunction ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
Improvement Rate ◽  
The Mean

Abstract OBJECTIVE We performed a retrospective patient chart review to determine the feasibility and safety of en bloc resection of lamina and ossified ligamentum flavum in the treatment of thoracic ossification of ligamentum flavum (OLF). METHODS From January 2000 to June 2006, 36 patients with thoracic OLF underwent en bloc resection of lamina and ossified ligamentum flavum by a burr-grinding technique. The range of resection included one lamina superior and one lamina inferior to the diseased segments. Ossified dura mater was removed if present, and simultaneous repair was carried out. RESULTS The mean preoperative Japanese Orthopedic Association (JOA) score (an evaluation system for thoracic myelopathy with a total score of 11 points) was 5 points (range, 3–9 points). The mean JOA score at the last follow-up visit (mean follow-up period, 3.9 years) was 8.44 points (range, 6–11 points). The range of improvement was from 2 to 6 points, and the mean improvement rate was 60.5% (range, 33.3%–100%). No postoperative aggravation of neurological dysfunction, leakage of cerebrospinal fluid (CSF), wound infection, kyphosis, or recurrence occurred. A CSF cyst found in one patient 3 weeks postoperatively was absorbed automatically after 10 months. CONCLUSION The en bloc resection technique described here is both safe and effective.

scholarly journals Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e025803 ◽  
Author(s):  
Maogen Tao ◽  
Xiaobo Zhou ◽  
Meiqing Hu ◽  
Jun Pan
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Local Recurrence ◽  
Curative Resection ◽  
Meta Analysis ◽  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
En Bloc

ObjectivesTo investigate the treatment effects of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC).DesignMeta-analysis.MethodsWe systematically searched three electronic databases, including PubMed, EmBase and the Cochrane library for studies published with inception to January 2018. The eligible studies should be evaluated for the efficacy and safety of ESD versus EMR for patients with EGC. The summary ORs and standard mean differences (SMDs) with 95% CIs were employed as effect estimates. Sensitivity analyses were conducted to evaluate the impact of single study on overall analysis. Subgroup analyses were performed for investigated outcomes to evaluate the treatment effects of ESD versus EMR for patients with EGC with specific subsets.ResultsEighteen studies, with a total of 6723 patients with EGC, were included in final analysis. The summary ORs indicated that patients with EGC who received ESD were associated with an increased incidence of en bloc resection (OR: 9.00; 95% CI: 6.66 to 12.17; p<0.001), complete resection (OR: 8.43; 95% CI: 5.04 to 14.09; p<0.001) and curative resection (OR: 2.92; 95% CI: 1.85 to 4.61; p<0.001) when compared with EMR. Furthermore, ESD was associated with lower risk of local recurrence (OR: 0.18; 95% CI: 0.09 to 0.34; p<0.001). In addition, there was no significant difference between ESD and EMR for the risk of bleeding (OR: 1.26; 95% CI: 0.88 to 1.80; p=0.203). Though, ESD was correlated with greater risk of perforation (OR: 2.55; 95% CI: 1.48 to 4.39; p=0.001), and longer operation time (SMD: 1.12; 95% CI: 0.13 to 2.10; p=0.026) as compared with EMR. Additionally, several different features observed in included studies and patients could bias the effectiveness of ESD versus EMR in patients with EGC.ConclusionsESD is superior than EMR for en bloc resection, complete resection, curative resection and local recurrence, while it increased perforation risk and longer operation time.

scholarly journals Primary Aneurysmal Bone Cyst and Its Recent Treatment Options: A Comparative Review of 74 Cases

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2362
Author(s):  
Nils Deventer ◽  
Martin Schulze ◽  
Georg Gosheger ◽  
Marieke de Vaal ◽  
Niklas Deventer
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Bone Cyst ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Treatment Modalities ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Cyst Volume ◽  
Comparative Review ◽  
The Mean

(1) Background: An aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor. Different treatment modalities are described in the literature i.e., en bloc resection, intralesional curettage and percutaneous sclerotherapy. (2) Methods: This single-center study is a review of 74 patients with primary ABCs who underwent a surgical treatment or polidocanol instillation. Cyst volume measurements using MRI and conventional radiographs are compared. (3) Results: The mean pre-interventional MRI-based cyst volume was 44.07 cm3 and the mean radiographic volume was 27.27 cm3. The recurrence rate after intralesional curettage with the need for further treatment was 38.2% (13/34). The instillation of polidocanol showed a significant reduction of the initial cyst volume (p < 0.001) but a persistent disease occurred in 29/32 cases (90.6%). In 10 of these 29 cases (34.5%) further treatment was necessary. After en bloc resection (eight cases) a local recurrence occurred in two cases (25%), in one case with the need for further treatment. (4) Conclusions: MRI scans are superior to biplanar radiographs in the examination of ABCs. Sequential percutaneous instillations of polidocanol are equally effective in the therapy of primary ABCs compared to intralesional curettage. However, several instillations have to be expected. In a considerable number of cases, a conversion to intralesional curettage or en bloc resection may be necessary.

Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients

2020 ◽  
Vol 32 (1) ◽  
pp. 89-97
Author(s):  
Shaohui He ◽  
Yuduo Xu ◽  
Jialin Li ◽  
Yue Zhang ◽  
Haifeng Wei ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Ki 67 ◽  
Factors Affecting ◽  
The Mean ◽  
Piecemeal Resection

OBJECTIVELeiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS).METHODSTwelve patients presented to the authors’ institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant.RESULTSThe mean patient age was 49.7 ± 12.9 years (range 22–73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0–15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5–21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6–78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS.CONCLUSIONSSurgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.

scholarly journals Treatment of Gastric Epithelial Tumours by Endoscopic Submucosal Dissection Using an Insulated-Tip Diathermic Knife

2011 ◽  
Vol 25 (2) ◽  
pp. 97-101 ◽  
Author(s):  
Xu Li Hua ◽  
Qian Jun Bo ◽  
Gu Liu Gen ◽  
Lu Fei ◽  
Wang Ya Min ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Curative Treatment ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Biopsy Specimens ◽  
Mean Diameter ◽  
Epithelial Tumours ◽  
The Mean

BACKGROUND: Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre- and early malignant gastrointestinal lesions.OBJECTIVE: To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated-tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens.METHODS: One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated.RESULTS: The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low-grade dysplasia and six were found to be high-grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery.CONCLUSIONS: ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and/or perforation. Differences in the interpretation of histological results among different pathologists and/or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies.

Upper facet joint en bloc resection for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum

2013 ◽  
Vol 19 (1) ◽  
pp. 81-89 ◽  
Author(s):  
Zhong Yang ◽  
Yuan Xue ◽  
Qin Dai ◽  
Chao Zhang ◽  
H. Fang Zhou ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Facet Joint ◽  
Neurological Status ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Pathological Examination ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
The Mean

Object The authors introduce a novel technique to treat thoracic myelopathy caused by ossification of the ligamentum flavum (OLF): upper facet joint en bloc resection. This surgical procedure avoids surgery to the most heavily compressed cord surface, contact with the cord, and cord injury. The epidural venous plexus bleeding point can be directly seen and easily controlled during the decompression. Methods Between January 2007 and January 2009, thoracic myelopathy caused by OLF was diagnosed in 38 patients using plain radiography, CT, and MRI, and diagnoses were confirmed by postoperative pathological examination. All upper facet joint en bloc resection procedures were performed in 2 steps. First, the bony structures above the upper facet joint surfaces were resected and the upper facet joints were isolated. Second, en bloc resection of the upper facet joint was performed by dissection of the junction between the pedicle and upper facet joint. Intraoperative neurological monitoring was performed in all cases. The modified Japanese Orthopaedic Association (mJOA) scoring system was used to assess neurological status. The degree of postoperative expansion of the spinal cord was calculated on axial MR images. The pre- and postdecompression Cobb angle was applied to assess the magnitude of local kyphosis. Results Of the 38 cases of OLF, 6 were single level, 12 were double level, and 20 were multilevel. Of the 92 ossified segments in this study, 23 (25.0%) were located in the upper thoracic spine (T1–4), 13 (14.1%) were located in the midthoracic spine (T5–8), and 56 (60.9%) were located in the lower thoracic spine (T9–L1). The mean intraoperative blood loss was 340 ± 54 ml. The neurological status improved during follow-up (mean 46.1 months) from a preoperative mean mJOA score of 5.39 ± 1.52 to 8.97 ± 1.22 points (t = 18.39, p < 0.05). The neurological function recovery rate ranged from 28.6% to 100%. The mean increase in pre- and postoperative kyphosis of the involved vertebrae was only 1.3° ± 1.6°. The increase in the cross-sectional area of the dural sac at the level of maximum compression suggested that decompression was complete. Conclusions Upper facet joint en bloc resection is effective and may be a reasonable alternative treatment choice for thoracic myelopathy caused by OLF.

scholarly journals The Knack and Pitfall of the Retropancreatic Nerve Plexus Hanging Maneuver for Pancreatoduodenectomy for Pancreatic Head Carcinoma.

2020 ◽  
Author(s):  
Naokazu Chiba ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
Toshimichi Kobayashi ◽  
Kosuke Hikita ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Celiac Axis ◽  
Nerve Plexus ◽  
R0 Resection ◽  
En Bloc ◽  
Hanging Maneuver ◽  
The Right

Abstract Background The efficacy of the hanging maneuver for the retropancreatic nerve plexus (RNP) to enhance the confirmation of the margin status and to facilitate en-bloc resection for pancreatoduodenectomy (PD). In this report, we present the knack and pitfall of the hanging maneuver of the RNP. MethodsThe exit of the hanging maneuver of the RNP is the left part of the superior mesenteric artery (SMA), and the entry is the cranial part of the celiac axis. The entry of the hanging maneuver was connected to the dissection line on the right side of the celiac axis. Thereafter, the tape of the hanging maneuver was pulled to the right side, and the RNP was deployed widely. Finally, the RNP was easily dissected using a sealing device other than IPDA ResultsIt is important to clarify the entrance and exit of the hanging taping in this procedure. This permitted the wide spaces between the SMA, SMV, and the resected side, and it was easier to identify the IPDA. By traction of the hanging maneuver tape, a clear line may be drawn between the resection side and the remaining side. ConclusionsWith the correct implementation of the hanging maneuver, we believe that it would be possible to obtain reliable R0 resection as well as a reduction in blood loss and operation time.

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